Archive for July, 2008

I’m publishing this on a public blog so that if I mysteriously disappear after making this proposal, you’ll know to investigate the major auto manufacturers and oil companies, but here’s the reasoning behind the boycott:

Say you need another car: Your child is turning 16, your old clunker is on it’s last legs, you’re just plain tired of your old car and want a new one, whatever the reason. You could buy a new car, nice and shiny, with that sweet smell of VOCs (volatile organic compounds) wafting from the upholstery, the latest and greatest gadgetry, a fresh coat of wax from the dealer. You’ll be paying $20-30K or more for the vehicle, then immediately lose 30% of the value just by driving off of the lot, and then proceed to pay $100 to fill the tank up every week. Sound good? Not really.

You could buy that car, but why would you buy a new car right now that crudely burns a dying and outdated 20th century fuel? Why not wait and buy a 21st century car – one fueled by electricity or hydrogen, one that burns waste vegetable oil or cellulosic ethanol made from agricultural by-products and recycled paper? Everybody knows that gas isn’t going to get significantly cheaper anytime soon, it will actually likely rise slowly for the next few years, then once we are irrefutably in the midst of peak oil and the world starts significantly restricting carbon emissions and taxes energy use, fossil fuel prices will skyrocket, making it impossible to cheaply travel and waste power like we had in the past. The products we buy and the energy we use to heat and power our homes will all be more expensive because they will be more precious. They will carry the true cost of extracting the resources, the human skill and labor, the overall impact on the environment, and the cost of recycling it at the end of their lives. This extra expense is not unfair, and once we understand the true costs of using the world’s resources, moderate our consumption, and decrease our footprint, we will probably actually save money in the long run. Buy making responsible, educated, and forward-thinking purchases now, you will be readying yourself for the coming change in energy infrastructure. You’ll be leaving the status-quo behind, and making intelligent plans for providing you and your family affordable and available transportation and power options in the future as energy prices rise. You’re insulating yourself from volatile changes in prices in gasoline, natural gas, electricity, and even food.

What I’m saying is, if you need another car, let the manufacturers know that you don’t want to run your car on fossil fuels, it’s bad for the environment, expensive, causes global political unrest and contributes to terrorism, and the technology is available right now to move the same distance at the same speeds without burning any gas, causing any emissions, or contributing to climate change. Make them give you another option, change their practices, divorce themselves from the corporate oil giants. If you need another car right now: go buy a cool used car, fix up a classic roadster, put yourself on the waiting list for a an Aptera, a Tesla Roadster, a Chevy Volt, or a Prius Plug-in Hybrid – you’ll have a next-generation car within the next 1-3 years depending on your choice, not really all that long! Plus, you’ll have killer eco-street cred. Better yet, make your car stretch – use the money you saved to buy some great commuter bikes, an xtracycle, or an electric scooter or motorcycle. If you want a project, build your own electric car or motorcycle. There are so many options besides buying a new fossil-fuel powered car, it’s really just ridiculous to do it right now.

Our entire energy infrastructure is set to change over the next decade, why would you waste your hard-earned money buying in to a dying paradigm? The age of cheap oil is over. Regardless of drilling offshore or in the Arctic Wildlife Refuge, irregarding the horribly polluting tar sands projects in Canada, and outside of political deals and wars meant to keep oil flowing to us, fossil fuel demand is increasing and supply is dwindling. Hard core oil exploration and exploitation will be more expensive, less productive, and more environmentally hazardous than ever before. At our current rate of increasing oil consumption, the government-subsidized “resource depletion projects” will at best only postpone the impending energy crisis for a short time if at all. If we’re lucky, they might at best keep fossil fuel prices relatively stable as we actively transition off of them in favor or renewable resources.

It’s time to invest in the future and stop fueling the climate crisis and start making smart choices for your family’s future and vow never to buy another new fossil-fuel powered vehicle. Buy electric, buy used, get a bike instead, become a public transportation expert, stop contributing to the problem and consume like you give a damn.

My grandmother ended up with an MRSA toe infection and to give my parents a good understanding of what to worry about and, more importantly, what not to worry about, I wrote this “mini-article” and thought it would be useful for those of you worrying about this up and coming infection.

MRSA, or Methicillin Resistant Staph Aureus, has unfortunately become the norm of skin infections. For the past few years In the ER we’ve been treating almost all of our skin infections empirically for MRSA, since in that time we’ve seen it increasing in frequency, so that more than 50% of our skin infections are now due to it. It’s become endemic and there’s not much you can do to prevent it these days. Don’t get too worried yet, though, it usually doesn’t make you too sick as long as it’s treated, and often times people will have just an isolated infection.

Interestingly, despite our increasingly germophobic culture, using UV-irradiated toothbrushes, largely unnecessary hand sanitizer gels, and the ubiquitous antibacterial soap, we are unfortunately beginning to generate a place for these products, with ever-increasing virulence of viruses and bacteria and a continuing rise in resistance against traditional antibiotics.
These hypersanitation products have not been traditionally necessary, since the human immune system, along with skin anatomy and a commensualistic relationship with “friendly” bacteria, have been enough to fight off the majority of invasive skin infections fairly well. Bacteria, however, are resourceful. They are highly adaptable to environmental pressure, and since they multiply at logarithmic rates, doubling a colony size in as little as 10 minutes time, the opportunity for mutation and the induction of “resistance genes” and other advantageous traits is significant.

The rampant use of antibiotics for agriculture has likely been one of the biggest evolutionary pressures for modern bacteria, with MRSA being cultured in higher rates in factory farm workers than in the general population and resistant E. coli strains being found in various human food products. This has been an interesting biologic process that has significantly increased human disease and has been due in large part to politics and economics rather than common sense and forward thinking. Michael Pollan’s book, “The Omnivore’s Dilemma”, details the whole sordid tale – basically, in the early part of the century, as farmers got better at growing things, due to cheap fuel oil, advances in machinery, petroleum-based fertilizers and pesticides, and other improvements in technology, crop yields increased, generating a huge grain surplus in the 1930’s, driving the price of grain to almost nothing. With all that extra corn, we figured out that we could use the surplus super-cheap grain to feed cattle, the cattle grow quickly and chubbily (the marbling us Americans all like), but at the cost of their health. A ruminant’s stomach has evolved to eat grass, not corn, so feeding cows grain causes liver infections, bloat, and sometimes death in 30% or more of grain-fed cattle if not treated with antibiotics. This is one of the main reasons I’m trying to decrease red meat intake and when I do eat it, stick to grass-fed beef (besides the 10-fold increase in resource use to produce meat over vegetables, and the cruel factory farming techniques used in the industry today). The point is, because of the grain use, we’re using inordinate and otherwise unnecessary quantities of antibiotics to treat whole herds of cows, and we’re seeing an increase in microbial resistance and thereby an increase in human disease as a result.

I’ve come to think of antibiotic resistance as an unending race of technology vs. nature. We will never eradicate disease, and the very act of fighting it pressures it towards resistance. Fighting it too hard leads to more resistance, but not fighting it enough increases human morbidity and mortality. I suppose the answer is informed but cautious prudence in the use of antibiotics.

So what do you do about it? Aside from any political action or dietary change, what happens if you or a loved one gets MRSA? If you end up colonized with MRSA, all it means is that the normal Staph bacteria on your skin are now a bit tougher and more opportunistic, so it becomes easier to get skin infections, infected hair follicles, boils, abscesses, and other tasty low-level infections. Sometimes it can progress to worse problems, but if lesions are drained early, the proper antibiotics are given when needed (Bactrim, a sulfa drug, or a combination of clindamycin and rifampin is best right now where we are, but resistance profiles vary significantly depending on where you live). The biggest mistake I see practitioners make is to give antibiotics instead of draining an abscess. Once you get the pus out (I know, it’s pretty nasty, but welcome to my world), it usually starts to improve fairly quickly and often actually doesn’t need antibiotics at all. So, if you start to get big zits or boils, you actually need to try to “pop” them and allow them to drain. Sometime heating pads or moist heat will help draw a developing abscess to the surface of the skin where it can drain. When we have to incise them, we actually leave a packing in for a few days so that it can start to heal from the inside out, otherwise they seal themselves up and continue to fester. Once you start seeing recurrent MRSA in the household, it’s probably a good idea to have everyone use intranasal Bactoban ointment in the nose, three times a day, for 5 days – this is because a common place for MRSA colonization is the nose. I would probably give the bathrooms a good once-over with some disinfectant, chlorhexidine kills MRSA and we use it in the hospital, but I’ll have to check to see if it’s available to the general public.

After all that, the message is: don’t worry too much, just keep an eye out and take care of infections when they come along.

Climate Change and Peak Oil

In the United States, we use over 20 million barrels of oil per day, over 7 billion barrels per year, importing more than half of this volume from Africa, the Middle East, Russia, and other oil-producing states.
In purchasing this oil from other parts of the world we put billions of dollars per year into the hands of oil shieks, outdated theocratic rulerships, radical Islamic militants, and even terrorists. The pursuit of this oil has many costs, including the billions of American tax dollars spent on a war that is largely political in order to secure our access to this resource. Already unstable, any breakdown in the current oil economy will lead to skyrocketing fuel prices for Americans. Even the experts within the oil industry predict "peak oil", that is, the highest possible global oil production, to come anywhere within the next 10-50 years. After that point the maximum amount of oil that we can pump out of the ground will decline despite the growing demand for oil for energy, plastics, gasoline, jet fuel, and the many other uses for petroleum. This is a second major reason for a fuel cost spike, that will hit our economy terribly, from which we may not ever recover.
A second major global crisis that is intimately intertwined with energy is climate change. The latest data suggests that the polar ice caps are melting even faster than previously predicted, leading to erratic weather patterns, severe droughts and floods, and rising sea levels. If our current energy consumption continues to grow as predicted, we will have set the stage for severe natural disasters displacing millions of people from their homes, killing an unestimateable number of humans and animal species, costing billions of relief dollars, as well as costing more than 5% per year of global economic growth indefinitely. These two issues go hand in hand – our voracious appetite for energy requires the burning of more and more fossil fuels which in turn leads to more of the CO2 emissions that cause global warming. This is not supposition and is not theory. It is fact. There are many resources to support these estimates and projections from leading politicians, economists, climate experts, geologists, and other experts in their fields.
What this means is that this energy crisis will occur within many of our lifetimes and all of our children's lifetimes. We cannot leave the downfall of our civilization and the scarring of our globe as a legacy to our next generation. Do not take the media’s word, or my word for that matter, research it for yourself so you understand the dire position of our current crises.